BILL NUMBER: SB 429	CHAPTERED  10/10/99

	CHAPTER   741
	FILED WITH SECRETARY OF STATE   OCTOBER 10, 1999
	APPROVED BY GOVERNOR   OCTOBER 7, 1999
	PASSED THE SENATE   SEPTEMBER 3, 1999
	PASSED THE ASSEMBLY   JULY 6, 1999
	AMENDED IN ASSEMBLY   JUNE 21, 1999
	AMENDED IN SENATE   APRIL 6, 1999

INTRODUCED BY   Senator Monteith

                        FEBRUARY 16, 1999

   An act to amend Section 16946 of the Welfare and Institutions
Code, relating to human services.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 429, Monteith.  County health services.
   Existing law provides that the Hospital Services Account in the
Cigarette and Tobacco Products Surtax Fund is available for
appropriation for payment to public and private hospitals for the
treatment of hospital patients who cannot afford to pay for that
treatment and for whom payment for hospital services will not be made
through private coverage or by any program funded in whole or in
part by the federal government.
   Existing law provides for the allocation of money derived from the
Hospital Services Account to each county contracting with the State
Department of Health Services under the County Medical Services
Program, also known as a CMSP county, and to a county that
administers its own county health services program, also known as a
MISP county.
   Existing law requires as a condition of a county receiving funding
under these provisions that each county and noncounty hospital,
among other things, maintain the same number and classification of
emergency room permits and trauma facility designations as existed on
January 1, 1990.
   Existing law provides that if San Luis Obispo County or Stanislaus
County discontinues the provision of acute inpatient care services
they may surrender their emergency room permits without penalties if,
in the alternative, designated requirements are met, including,
delivering specific alternative services.
   This bill would add new requirements, related to the system of
delivering alternative services, for San Luis Obispo County and
Stanislaus County to act pursuant to this provision.  This bill would
provide that if these counties meet the designated requirements they
shall be eligible to receive county funding pursuant to these
provisions in the manner specified in the bill.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  Section 16946 of the Welfare and Institutions Code is
amended to read:
   16946.  (a) The Hospital Services Account portion of each county's
allocation pursuant to Sections 16932 and 16941 shall be divided
into two amounts by:
   (1) Multiplying the Hospital Services Account funding portion by
the percentage specified in paragraph (5) of subdivision (c) of
Section 16945.
   (2) Multiplying the amount of the Hospital Services Account
funding portion by the percentage specified in paragraph (6) of
subdivision (c) of Section 16945.
   (b) The amount of each county's Hospital Services Account funding
portion calculated in paragraph (1) of subdivision (a) shall be used
for payment or support of services provided on or after July 1, 1989,
by noncounty hospitals.  Beginning in the 1991-92 fiscal year and
annually thereafter, these amounts shall be reduced by dividing each
county's amount by the total amount for all counties, multiplied by
the sum of twelve million dollars ($12,000,000).  This amount for
each county shall be further divided into two equal parts, as
follows:
   (1) (A) The first part shall be allocated to each noncounty
hospital within a county in amounts determined by multiplying the
percentages specified in paragraph (7) of subdivision (c) of Section
16945 by the amount of the first part, and may be used for payment or
support of services provided by noncounty hospitals to any eligible
patient treated at any time during the fiscal year of the allocation.

   (B) Funds distributed during fiscal years subsequent to the
1989-90 fiscal year shall be accounted for on a quarterly basis.
   (C) For the 1989-90 fiscal year, noncounty hospitals shall provide
the demographic data specified in paragraph (2) of subdivision (b)
of Section 16918 on a minimum of 5 percent of patients for whom
services are paid for in whole or in part by funds allocated pursuant
to this paragraph, in addition to any other requirements specified
in Section 16918.
   (D) For the 1990-91 fiscal year and fiscal years thereafter,
noncounty hospitals shall provide data pursuant to the reporting
requirements specified in Section 16918 and shall provide posted and
individual notices pursuant to Section 16818 for the duration of any
quarter during which funds allocated pursuant to this paragraph are
used.
   (E) Amounts calculated pursuant to this paragraph shall not be
reduced or utilized to offset the costs of administering the Hospital
Services Account.
   (2) (A) (i) The remaining 50 percent of the funds from the
Hospital Services Account shall be distributed by the county to
hospitals, including those under contract with the county, to
maintain access to emergency care and to purchase other necessary
hospital services provided during the fiscal year of the allocation.

   (ii) In contracting for emergency care with hospitals in
neighboring counties, the county shall not impose conditions to
accept transfers that it does not impose on hospitals within its own
boundaries.
   (B) (i) Prior to distributing funds to hospitals, each county
shall consult with the hospitals and consider the historic and
projected patterns of care provided by hospitals, by geographic
catchment areas within both urban and nonurban areas, unique costs
associated with treating disproportionate numbers of severely ill
indigent patients, and disproportionate losses sustained by hospitals
in the provision of care.
   (ii) The county shall also consider the patterns of care of its
residents provided by Level I trauma care hospitals in contiguous
counties and may make proportionate allocations to those trauma
centers.
   (c) (1) The amount of each county's Hospital Services Account
funding portion calculated in paragraph (2) of subdivision (a) may be
used for the payment or support of services provided in county
hospitals or noncounty hospitals as determined by each county during
the fiscal year of the allocation.
   (2) Beginning in the 1991-92 fiscal year and annually thereafter,
the amount of each county's funding portion calculated pursuant to
paragraph (2) of subdivision (a) shall be reduced by an amount that
shall be calculated as follows:
   (A) Divide each county's amount of funding under paragraph (2) of
subdivision (a) by the total amount of funding under that paragraph
for all counties.
   (B) Multiply the quotient calculated pursuant to subparagraph (A)
by the sum of six million dollars ($6,000,000).
   (d) As a condition of receiving funds under this section and
Section 16932, each county shall require each county and noncounty
hospital to do all of the following:
   (1) (A) Maintain the same number and classification of emergency
room permits and trauma facility designations as existed on January
1, 1990.
   (B) (i) Any hospital that maintained two special permits for basic
emergency service on the effective date of this part shall be deemed
to have met the requirements of paragraph (1) of subdivision (d), if
each of the emergency rooms was located on separate campuses of the
hospital and was located not more than two miles from the other
emergency room.
   (ii) Clause (i) shall apply even if one of the emergency room
permits is surrendered after the effective date of this part.
   (2) Provide data and reports on the use and expenditure of all
funds received.  This information shall be in a form and according to
procedures specified by the county and the department.
   (3) Assure that funds received pursuant to this section are used
only for services for persons who cannot afford to pay for those
services, and for whom payment will not be made through any private
coverage or by any program funded in whole or in part by the federal
government.
   (e) (1) If a county or noncounty hospital does not comply with
this section, the county shall recover funds received by the hospital
as follows:
   (A) For any violation of paragraph (1) of subdivision (d), the
county shall recover that portion of the funds received which equal
the ratio of the number of months not in compliance to 12 months.
   (B) For any violation of paragraph (2) of subdivision (d), the
county shall recover all funds received.
   (C) For any violation of paragraph (3) of subdivision (d), the
county shall recover the difference between the amount received and
the amount for which the hospital can document that the funds were
used only for services for persons who cannot afford to pay for those
services and for whom payment will not be made through any private
coverage or by any program funded in whole or in part by the federal
government.
   (2) The county may deny further payments required by this section
until the hospital demonstrates compliance.
   (f) Funds withheld or recovered pursuant to this section may be
reallocated and distributed by the county pursuant to paragraph (2)
of subdivision (b).
   (g) (1) Except as provided in paragraph (2), funds allocated
pursuant to paragraph (1) or (2) of subdivision (b) which are not
expended because a hospital does not participate shall be
redistributed pursuant to paragraph (2) of subdivision (b).
   (2) If no noncounty hospitals remain to participate, the county
may distribute those unexpended funds pursuant to subdivision (c).
   (h) (1) In any county that comprises not more than one-half
percent of the total state population and in which there are a county
hospital and a noncounty hospital with emergency room permits
located within two miles of each other, the county hospital may
surrender its emergency room permit without any penalty for violation
of paragraph (1) of subdivision (d) if, in the alternative, all of
the following occur:
   (A) The county shall enter into a contractual arrangement with the
noncounty hospital.
   (B) The county and noncounty hospital shall provide for the
availability of at least the same level of emergency services and
specialty backup which the county hospital and noncounty hospital
provided prior to the surrendering of the emergency room permit.
   (C) The county shall establish sufficient capacity, including
evening and weekend coverage, in its urgent care clinic and other
outpatient clinics to provide for the same or greater level of urgent
care and nonemergency visits that were provided in the county
hospital emergency department in the calendar year prior to the
surrendering of the emergency room permit.
   (D) The county shall provide for adequate initial public hearings
and ongoing public notification and information, in Spanish and
English, on the availability of emergency, urgent care, and nonurgent
clinic services and how to obtain those services.  The county shall
provide for, as part of the ongoing public notification, an outreach
program to ensure that the medically indigent community, particularly
migrant and seasonal farmworkers, and cultural and linguistic
minority patients, are effectively made aware of the alternative
system of care and the ways to access it.
   (E) The county ensures that there are adequate Spanish translation
services and referral services on a 24-hour basis at the noncounty
hospital emergency department, and at the county hospital clinics,
during their hours of operation.
   (F) The county shall ensure, in planning for an alternative
delivery system as provided for in paragraph (C), participation of
those existing agencies providing health care services to the
uninsured and working poor medically indigent, including federally
qualified health centers and nonprofit community-based rural health
clinics.
   (G) The county shall ensure that its alternative delivery system
includes medical providers who are culturally and linguistically
competent to service the diverse medically indigent populations and
have been serving uninsured persons seeking care at the county
hospital prior to closing.  These providers shall include, among
others, nonprofit community-based safety net and traditional
providers currently serving both the uninsured and medically indigent
populations.
   (H) The county shall ensure that its alternative delivery system
does not provide less health care services and resources than that
being made available to the medically indigent and uninsured prior to
the closing of the county hospital.
   (2) The department shall annually review the county's compliance
with this subdivision.  If the department determines that the county
is not in compliance with this subdivision, it shall require the
county to recover funds and deny further payments pursuant to
subdivision (e) until compliance is resumed.
   (3) Any county that is permitted under paragraph (1) to surrender
its emergency room permit shall continue to fulfill its duties and
obligations to provide indigent care according to Section 17000.
   (i) Any county of the 20th class or the 24th class that
discontinues the provision of acute inpatient care services may
surrender its emergency room permit without any penalty for violation
of paragraph (1) of subdivision (d), provided that the county shall
enter into a contractual arrangement with at least one noncounty
hospital meeting the requirements of subdivision (d) and all of the
requirements of subparagraphs (A) to (H), inclusive, of paragraph (1)
of subdivision (h) are met by the county and the contracting
noncounty hospital, in which case paragraphs (2) and (3) of
subdivision (h) shall apply to that county.
   (j) Notwithstanding any other provision of law, any county of the
20th class or the 24th class that meets the requirements and
conditions of subdivision (i) shall be eligible to receive funds
distributed pursuant to any provision of this section equal to that
amount received by the county for the fiscal year immediately
preceding the year in which it discontinues the provision of acute
inpatient care services.  The amount calculated pursuant to this
subdivision shall be adjusted annually based upon the funding
available from the Hospital Services Account in the Cigarette and
Tobacco Products Surtax Fund.
